Personality Disorders
By Dr. Julius Meller M.D.
Personality describes a person's characteristic behavior in
response to his or her inner and outer experiences. It is
predictable and stable. A personality disorder occurs
when behavior differs from the range of variation found in most
people, being so severe and maladaptive, producing distress or
significant impairment of adaptive function.
Three Clusters (groupings) are recognized which can overlap:
Cluster A: The odd and eccentric persons in whom fantasy
thinking predominates with thought disorder under stress.
Cluster B: The dramatic, emotional and erratic behaviors
including theatrical, self-centered, antisocial or suspicious
tendencies or poorly controlled variations that may occur
including mood disorders.
Cluster C: The anxious or fearful persons dominated by worry
and avoidance of stressful situations, in which physical complaints
and indirect hostility occurs.
Cluster A:
Paranoid Personality Disorder is hypersensitive, tends to blame
others for his or her own problems, and tend to be bigots or jealous
and may be litigious. There may be a biological or familial
element. There is a pervasive perception of others being
threatening and mistrust is a feature. There is a tendency to feel
being a focus of attention and have logically defended beliefs, but
lacks odd behaviors. Psychotherapy and medications are helpful if
a trusting relationship is formed.
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Schizoid Personality Disorder shows isolated and withdrawn
lifestyles and lack of interest in social interactions. There may be
genetic factors. There is poor eye contact and they give short
responses, and interests are in non personal issues. There is a
vulnerability to psychotic (out of reality) reactions and
medications are important Psychotherapy might be sought. No
particular eccentricities.
Schizotypal Personality Disorder shows characteristics of odd and
strange behavior, thinking, mood speech and appearance. There
is magical thinking, peculiar ideas, with self-reference, few friends
and episodes of unreal experiences (stranger communications, and
have extra-ordinary events.) May believe they have special
powers under stress, with psychotic symptoms, and anti-psychotic
medications are often used.
Cluster B:
Histrionic Personality Disorders are dramatic with gestures and
language. Emotionality, which tends to be shallow and insincere,
is exaggerated with attention seeking behavior, temper tantrums
and tears. Apart from attention seeking, and marked
emotionality (complaints) there is a need for reassurance.
Psychotherapy involves giving up the acting to clarify unexpressed
deeper feelings (covered up) and may require appropriate
medications
Narcissistic Personality Disorder shows grandiose behavior
(elevated sense of self importance) and fantasies of success, with
over concern about self-esteem and self-image, and sensitivity to
criticism, with disturbed relationships. They lack empathy and
have chronic envy, sensitive to rejection, including work-related
and relationship problems. Psychotherapy involves giving up
narcissism (being self focused) in gaining empathy. Medications
for mood disorders are often required. These are challenging
problems, but they are law abiding.
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Borderline Personality Disorder is characterized by unstable
moods, behavior, personal relationships and distorted self-image,
with impulsivity, suicidal acts or self mutilation. There are
feelings of emptiness, boredom and also neurotic (anxiety) and
psychotic features episodically. Also found are chaotic sexuality,
substances abuse and fiscal irresponsibity. Always in crisis, with
mood swings and eating disorders. Treatment is a challenge, with
psychotherapy and judicious use of medication. Exclude brain
damage.
Anti-Social Personality Disorder is characterized by inability to
conform socially, but not always criminal, to a prior ADHD history
in some and usually conduct disorder (delinquency). The lack of
conscience and pathological lying are key features. There is ego
centricity and low frustration tolerance, showing with impatience,
impulsivity, irresponsibility and anti-authority acts. 75% exist in
prison populations. Often have substance abuse and alcoholism.
May have similar family members and parental abuse, with
genetic factors often in lower income groups, and brain damage in
some. Lack of empathy, with poor relationships and aggressive
behavior. Treatment is difficult, with poor results, improving with
institutionalization and group psychotherapy and behavioral
programs with work, as they run from relationships, fearing
rejection.
Cluster C:
Dependant Personality Disorder shows an intense need to be
taken care of, fearing abandonment, with a lack of self-confidence
to assume responsibility for their lives, being clinging
submissive and fearing separation. There is passivity and a search
for guidance, being pessimistic, and fearful of expressing sexual or
aggressive feelings (of disagreement). They may stay in an abusive
relationship. Therapy focuses on prior development to attain
independence with assertiveness training and medication for
anxiety and depression.
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Passive Aggressive Personality Disorder aggression is shown
passively by being obstructive, stubborn, with procrastination,
and inefficiency. They complain of not being understood or
appreciated, exaggerating personal misfortune. Often depressed
or alcoholic, with hostility or guilt. Therapy involves patient
confrontations and medications for complications.
Obsessive-Compulsive Personality Disorder is characterized by
perfectionism, concerns for rules and order, inflexibity and
indecisiveness. There is emotional constriction and stubbornness,
and an absence of compulsive thoughts and rituals. There is a
lack of spontaneity or humor, with detailed explanations,
difficulties to compromise, but eager to please those in authority,
as well as alienating people. The course is unpredictable, and
treatment is long and complex with medications for anxiety and
depression.
Avoidant Personality Disorder has intense sensitivity to rejection
in shy or timid persons. They seek companionship and need
uncritical acceptance, with low self-esteem. There is a liability to
social phobia and physical complaints. Psychotherapy depends on
establishing a supportive alliance. Learning new social skills is
difficult with poor self-esteem. Assertive training is helpful with
medications, as autonomic hyperactivity (stomach complaints,
blushing and sweating) often occurs.
There are other descriptions for personality disorders that are of
medical interest which are being reviewed for coming
classifications including sado-masochism, self-defeating behaviors,
and general groups due to medical conditions.
However it is this group that demands much time, and is a large
group presenting with a full range of symptoms. Skillful
treatment can be most helpful, particularly for complications, to
reduce medical consultations and crises, to improve the quality of
life. Major problems are with those who have addictions and
mood disorders, which need control to benefit from treatment.
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Acknowledgement: Kaplan and Sadock, 4th Edition, Pocket
Handbook of Clinical Psychiatry (2005)
Criteria used are from DSM IV,
American Psychiatric Association
Note: Personality Disorders are pervasive in clinical practice and
in various degrees in the population with quoted incidences from
surveys that invariably underestimates the real incidence.
Most individuals tend not to recognize their recurrent problems
as part of an identifiable pattern of disturbance over many years.
These problems may require help in its own right, because of the
frequently associated complications, especially of mood disorders,
drug dependence, failed work adjustments or relationships that
are the presenting issues.
Some may have a dominant sexual deviation, which inhibits
seeking help, due to social prohibitions and suffer or cause others
to suffer the consequences.
The purpose of this article is to help those who are in these
repetitive circumstances, to recognize these problems by
describing the established and fully developed forms of known
disorders described above in the psychiatric literature, and found
in clinical practice.
After the acute presenting issues are dealt with, most persons
seek discharge from treatment or decide on their own to quit.
Not all may require further professional help, and many pursue
social support groups or self-aid sites.
It is my wish to help persons use their own discretion in
considering their own circumstances to make these decisions, to
voluntarily decide to seek, at least, a professional opinion.
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